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Are We Really Surprised By Our Infant Mortality Rate?

According to the NCHS Data Brief (10/08), the infant mortality rate declined during the 20th century but has not declined significantly since 2000. Researchers, policy makers, and parents are concerned about the historically recent stagnation in the infant mortality rate. This fact in and of itself does not concern me – the rate that is. What does concern me is that the US infant mortality rate is HIGHER than the rates of most other developed countries. We tie Slovakia and Poland.

Increases in preterm birth • and preterm-related infant mortality account for much of the lack of decline in the United States’ infant mortality rate from 2000 to 2005.1

I was just reading a story posted by a woman who hopes to VBAC. She is going to have to change providers as it is clear that the doctor who insisted on inducing her at 39 weeks is not supporting her wishes. It seems as though this woman is the perfect VBAC candidate, so I’m not sure what the OB is thinking. 39 weeks. If you’re having to induce at 39 weeks then clearly the baby isn’t ready. Any baby who is born according to a doctor’s timeline (or via the rare patient-requested RCS) risks being born premature and suffering problems associated with pre-term birth.

The United States’ international ranking fell from 12th in 1960 to 23d in 1990, and to 29th in 2004.3

It’s particularly concerning to look at the differences in infant mortality rates for certain racial/ethnic groups in the US. The non-Hispanic black rate for 2004 was 13.63 (!!!), and closer to home, the rate for American Indians or Alaska Natives was 8.06. The report says that many differences in the infant mortality are unexplained.

I find it quite interesting how term birth is defined in this report – “[b]irth from 37 to 41 completed weeks of gestation.”4 So, obviously there is a push to move due dates forward. In my book, just about any baby that is taken early is pre-term. Some babies need to “bake” longer. I have a friend who pretty consistently gestates her babies 42+ weeks. That is normal for her and her babies. It is distressing to see term birth defined as 37 to 41 instead of the 38 to 42 birth month to which I have grown accustomed. Is anyone looking at how pushing women to deliver early is contributing to pre-mature birth and complications in the “term” birth cohort?

1. Preterm birth is considered to be birth at less than 37 completed weeks gestation.
2. Linked Birth/Infant Death Data Set and Preliminary Mortality Data File, National Vital Statistics System.
3. National Center for Health Statistics. Health, United States, 2007 with Chartbook on Trends in the Health of Americans. Hyattsville, MD: 2007.
4. MacDorman, Marian F. “Recent Trends in Infant Mortality in the United States.” NCHS Data Brief, No. 9 (October 2008). Accessed via http://www.cdc.gov/nchs/data/databriefs/db09.pdf; 10/15/08.